Tanya Lynn Petaccio, CRNP

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

SPO33194 Issued in PA

Practice address

1290 Blakeslee Boulevard Dr W Ste 1
Lehighton, PA 18235-9352

Phone

(484) 934-1155

Fax

(484) 727-9991

NPI assigned

Jul 18, 2025

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in PA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2025

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• 942 Psychiatric Services

  • Psychiatric/Mental Health Nurse Practitioner
  • Lehighton, PA
  • NPI 1497485510
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1752796800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1752796800000",
    "number": "1740172253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1290 BLAKESLEE BOULEVARD DR W STE 1",
            "city": "LEHIGHTON",
            "state": "PA",
            "postal_code": "182359352",
            "telephone_number": "484-934-1155",
            "fax_number": "484-727-9991"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1290 BLAKESLEE BOULEVARD DR W STE 1",
            "city": "LEHIGHTON",
            "state": "PA",
            "postal_code": "182359352",
            "telephone_number": "484-934-1155",
            "fax_number": "484-727-9991"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETACCIO",
        "first_name": "TANYA",
        "middle_name": "LYNN",
        "credential": "CRNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-07-18",
        "last_updated": "2025-07-18",
        "certification_date": "2025-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "PA",
            "license": "SPO33194",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kelsie Pane, PA-C
• Tatyana Pankratova, M.D.
• Jared Paster, DO
• Frank R Penater, MD
• Perfect Balance Boutique
• Phoenix Rehabilitation and Health Services, Inc.
• Samantha Postupack, M.A. CCC-SLP
• Luke John Price, PA-C
• Eric Michael Pridgen, MD
• Professional Care Partnership, LLC

• Psychiatric/Mental Health Nurse Practitioner in Lehighton, PA
• Providers in Lehighton, PA by specialty
• Psychiatric/Mental Health Nurse Practitioner in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.